外侧滑车延长截骨术。
Lateral trochlear lengthening osteotomy.
机构信息
Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland.
出版信息
Arch Orthop Trauma Surg. 2021 Oct;141(10):1721-1730. doi: 10.1007/s00402-020-03736-5. Epub 2021 Feb 24.
INTRODUCTION
The purpose of this study was to describe the indications and technical aspects as well as evaluate the clinical and functional outcome of lengthening osteotomy of the lateral trochlear ridge in patients with patellofemoral pain and/or patella instability and presence of trochlear dysplasia Dejour type A or lack of Dejour type dysplasia and short lateral articular trochlea.
MATERIALS AND METHODS
Six consecutive adult patients were treated with a lateral trochlear lengthening osteotomy. Five patients received a concomitant medial patellofemoral ligament reconstruction. Three patients had prior patella stabilization surgeries. Trochlea dysplasia (Dejour classification), Caton-Dechamps index, tibial tubercle trochlear groove (TT-TG) distance, patellar tilt and lateral condylar index were measured in preoperative MRIs. Clinical and functional evaluation included the Kujala Anterior Knee Pain Scale, the Lysholm Knee Score, the Tegner Activity Score, a subjective evaluation form and isokinetic muscle strength.
RESULTS
Four patients had a Dejour type A dysplasia, two patients had no dysplasia. The mean (range) Caton-Dechamps index was 1.09 (0.95-1.16), TT-TG distance 10.9 mm (9.2-15.6 mm), patellar tilt 15° (4-32°) and lateral condylar index 82.0% (74-90%). One patient was lost to follow up, all others were followed for 2-5 years. All patients were satisfied with the clinical outcome. The Lysholm score increased from 55 (37-79) to 89 (76-100), the Tegner activity score from 3.6 (2-6) to 5.6 (5-7). The Kujala score postoperative was 90 (75-96). Some but not all patients had full strength recovery compared to the contralateral leg.
CONCLUSION
We recommend measuring the lateral condylar index and considering the indication of a lateral trochlear lengthening osteotomy as an additional or isolated procedure in selected patients with trochlear dysplasia Dejour type A or lack of dysplasia and short lateral articular trochlea depending on the extent of the patellar instability.
LEVEL OF EVIDENCE
Level IV, Case Series.
TRIAL REGISTRATION NUMBER
NCT04378491, clinicaltrials.gov, May 7, 2020.
引言
本研究旨在描述外侧滑车嵴延长截骨术的适应证和技术要点，并评估其治疗髌股疼痛和/或髌骨不稳定伴滑车发育不良 Dejour 型 A 或无 Dejour 型发育不良且滑车外侧关节面短小患者的临床和功能效果。
材料与方法
对 6 例连续成年患者进行外侧滑车延长截骨术治疗。5 例患者同时行内侧髌股韧带重建术。3 例患者曾行髌骨稳定手术。术前 MRI 测量滑车发育不良（Dejour 分类）、Caton-Dechamps 指数、胫骨结节滑车沟（TT-TG）距离、髌骨倾斜角和外侧髁指数。临床和功能评估包括 Kujala 膝关节前痛量表、Lysholm 膝关节评分、Tegner 活动评分、主观评估表和等速肌力测试。
结果
4 例患者存在 Dejour 型 A 发育不良，2 例患者无发育不良。Caton-Dechamps 指数平均（范围）为 1.09（0.95-1.16），TT-TG 距离 10.9mm（9.2-15.6mm），髌骨倾斜角 15°（4-32°），外侧髁指数 82.0%（74-90%）。1 例患者失访，其余患者随访 2-5 年。所有患者对临床效果均满意。Lysholm 评分从 55（37-79）增加至 89（76-100），Tegner 活动评分从 3.6（2-6）增加至 5.6（5-7）。术后 Kujala 评分 90（75-96）。与对侧相比，虽然部分患者但并非所有患者的肌力完全恢复。
结论
我们建议在 Dejour 型 A 滑车发育不良或无发育不良且滑车外侧关节面短小的患者中，根据髌骨不稳定的程度，将外侧滑车延长截骨术作为附加或单独的手术，测量外侧髁指数并考虑其适应证。
证据水平
IV 级，病例系列研究。
临床试验注册号
NCT04378491，clinicaltrials.gov，2020 年 5 月 7 日。
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